The Roller Coaster Ride Continues

Based on a doubling of my PSA from 2.1 to 4 in about 2 years, my urologist did a biopsy on May 27. On June 8, I learned I had PCa with Gleason 7 (3+4) in 1 core. I had a consult with a more experienced urologist and told him I want to send the slides to Dr. Epstein for a second opinion. He thought that was an excellent idea. Dr. Epstein's report said although atypical and highly suspicious for cancer, he couldn't establish a definitive diagnose. He suggested a repeat biopsy.

The biopsy was repeated on July 29 by my regular urologist. A few days ago, he told me there are 2 cores that are atypical - not cancer, however, the pathologist was waiting for a second opinion from Dr. Victor Reuter, Vice Chairman, Department of Pathology at Sloan Kettering. According to my urologist, Dr. Reuter is a world renown pathologist. I received Dr. Reuter's report today and it says there are 2 cores that are Gleason 6 (3+3). Dr. Reuter was only sent the atypical slides, which are in different areas of the prostate. The samples taken from the area of the first "Gleason 7" diagnosis are benign (according to the pathologist's report).

In Dr. Reuter's report, he says he doesn't fault anyone for calling these cores atypical, however, he is confident calling them malignant based on……......., which supports his diagnosis. He also said “In this day and age, treatment is likely not to differ, at least at his institution."

I told my doctor that I will be sending the slides to Dr. Epstein for a "third" opinion. He emphasized that I have cancer. Notwithstanding this, I will make my treatment decision based on Dr. Epstein’s diagnosis.

My doctor says that I'm now a candidate for AS since my diagnosis is Gleason 6. When it was a Gleason 7 (3+4), he said I needed treatment. He also told me reading biopsy slides is not an exact science. That’s pretty obvious.

Because I can't have an MRI, I don't know if AS makes sense for me. My doctor said the AS protocol is to have a PSA test every 6 months and repeat the biopsy yearly. If I decide on AS, I may look for a more structured program, rather than stay with my doctor.

I feel like I'm on an emotional roller coaster. I have to wait for Sloan Kettering to return the slides to the pathologist at which time I will have them sent to Dr. Epstein. Dr. Epstein and Dr. Reuter have coauthored papers together, however, as best as I can determine, Dr. Reuter is a urologic pathologist not a prostate pathologist.

More to come.

Mitch

Mitch, hang in there. The good news is...and there is plenty of it...even at a single G7 core, you would qualify for most AS programs, and that might not be a bad idea at your age, particularly with your heart issues.

The "atypical but not cancer" is a really good thing. I don't recall if you shared where you are located.....

about the f/u biopsy... Even better than mpMRI-targeting is a transperineal mapping biopsy. No magnets required.

Another option is to fly out to sunny (and drought-ridden, and smoky-from-wildfires) Southern California and pay Duke Bahn in Ventura $700 to do a Color Doppler Ultrasound (he also does biopsies at the same time for $$ or you can take the print-outs to your hometown uro for a targeted biopsy).

I agree with TA, get the transperineal biopsy. Having been to Duke Bahn, of course that is one of the best ways I would recommend to target a leasion and do a biopsy on it. He charges an extra $250 if he has to do the biopsy while you are on the table. Good luck with your diagnosis search. Take care. -JR